An Overview of the "new" Constitutional Framework.
Set out below is a précis of the NHS Constitution, designed to provide an overall understanding of the document and its interpretation.
The Constitution was developed as part of the NHS ‘Next Stage Review’, as being just one of a number of recommendations in Lord Darzi’s Report – ‘High Quality Care for All’ published on the 60th Anniversary of the NHS. It is intended to be an enduring and living document, renewed every 10 years which “is founded on a common set of principles and values that bind together the communities and people it serves be that patients, the public or NHS staff”.
The NHS Constitution is intended to define the guiding principles of the NHS in England, codify existing (legal) rights of its stakeholders, define pledges which the NHS is committed to achieve and also sets out a list of core values which bind not just the NHS but stakeholders together.
The NHS Constitution (for England) took effect on 21 January 2009 after going through a vigorous consultation process.
The core purpose and values of the NHS will be reinforced by placing a new legal duty on NHS service providers (including third sector providers and independent organisations), and commissioners of NHS services to have regard to the constitutional framework. This legal duty is contained within the current Health Bill, which was introduced to Parliament on 15 January 2009, and which is currently at the final stages of its parliamentary process; and is expected to take effect shortly. The Health Bill also sets out the procedure for reviewing and amending the NHS Constitution and its associated documentation.
The document itself is refreshingly succinct, consisting of 12 pages and is easy to read. It is however accompanied by several key documents which it is intended are read alongside the Constitution, including –
a) The Handbook to the NHS Constitution
This document is wide ranging and provides current guidance, details and interpretation of the content of the Constitution and the legal framework on which it is based;
b) Statement of NHS Accountability
This provides a statement of the current structure of the NHS and the role/ responsibilities of each of its parts.
The vision which draws together the NHS Constitution is twofold -
1 It brings together in one document what all stakeholders (staff, patients and the public taxpayers) can expect from the NHS. As part of this vision the Constitution is intended:
a) To inform the basis of the professional relationship between patients and staff.
b) To reaffirm that the NHS provides a service for all, based on clinical need.
c) To detail the existing rights of stakeholders and set out for the first time new rights for patients, and what individuals can do should they feel that those rights are being infringed.
d) To distinguish between rights (those that patients/public and staff are legally entitled to), and pledges to improve services and working environments which the NHS is striving towards.
e) To set out principles and values to guide how all parts of the NHS, as well as third sector and other providers supplying NHS services will be required to take decisions.
2 At the same time the NHS Constitution is intended to be a long term vision of the way the NHS should operate in terms of patient care to secure the long term future of the NHS.
Therefore the aims of the NHS Constitution can be seen as follows:
a) To secure a practical working NHS service for the future by means of a living NHS Constitution which is renewed every 10 years, and which reflects a process of consultation between staff, patients and the public.
b) To balance a need to ensure high quality free NHS services with value for money for the taxpayer.
c) To ensure that all stakeholders contribute to the effective and efficient operation of the NHS, by outlining what is expected of them, to what they are entitled in the broadest sense, and what they can do if these expectations are not met.
d) To also recognise that it is the commitment and professionalism of staff which is the key to providing high quality NHS care, and therefore the Constitution commits to addressing those issues which are considered to be the most important to staff as a result of the extensive consultation exercise.
The NHS Constitution itself is designed to be user friendly. Below I have set out a generic overview of the various parts of the Constitution. This is designed to provide a flavour of the NHS Constitution, which can be downloaded in full along with accompanying documentation at www.dh.gov.uk/nshconstitution.
There are seven principles which are intended to set out the core values of the NHS, and guide how all parts of the NHS as an organisation is expected to operate and take decisions. I have not reproduced these core values here, but these can be seen succinctly in the document itself.
Patients, members of the public and staff have legal rights
derived from a wide spectrum of statutory legislation
and common law practice. The NHS Constitution therefore
attempts to collate and set out a number of core patient, public
and staff rights which reflect legal obligations arising from
current legislation, and which legally as well as professionally,
individuals are entitled or can expect from their NHS
These rights are summarised in the Constitution, and explained in more detail in the NHS Handbook (which also sets out the specific legal source of each right). Similarly the process which individuals should follow if legal rights have not been met is set out within the Constitution.
In addition, the NHS Constitution endeavours to go beyond the legal minimum in each of the areas it has identified, and therefore outlines a series of pledges that whilst not legally binding, is also part of an ongoing commitment to provide high quality services.
The Constitution also endeavours to set out responsibilities so that individuals themselves take personal responsibility for helping the NHS to work effectively and efficiently; and to ensure that resources are used responsibly.
Likewise, the Constitution also includes expectations that reflect how staff should play their part in ensuring the success of the NHS and delivering high quality care.
The final page of the NHS Constitution sets out the NHS values designed through discussion with all stakeholders as a result of the consultation process, with the aspiration to “provide common ground for co-operation” and the intention of achieving the shared goals of all groups.
As previously outlined, the NHS Constitution is underpinned by the Health Bill introduced to Parliament on 15 January 2009.
That Bill is currently moving forward, and it is expected to become an Act of Parliament in the near future. The intention of the new legislation is to ensure that the Constitution endures as a “declaratory document” articulating existing rights, responsibilities and commitments in one place. Therefore subject to Parliamentary approval the legal duties which reinforce the Constitution are expected to come into force in the autumn of this year, although the actual constitutional document itself has already taken effect from 21 January 2009.
Nonetheless, notwithstanding the Health Bill is still subject to Parliamentary process, most organisations are already using and referring to the “spirit” of the Constitution in their decision making processes.
The NHS Constitution is intended to be placed at the heart of the NHS, and will require partnership and sustained commitment from everyone working across the service.
You can download the digital versions of: